The proposed research will investigate the decision process through which fifteen hospitals in a single HSA arrive at a decision to adopt or not to adopt selected medical technologies. The focus is on capital acquisitions which allow the exploitation of changes in medical science by physicians, although one innovation not requiring equipment is included. Lengthy interviews are planned with decision makers in the process including hospital administrators, board members, various types of physicians and others. Interviews are designed to draw out the motivations of various actors involved in adoption decisions to determine the relationships existing among interested parties, the organizational and social constraints affecting their actions, and the structure of the decision process. Characteristics of innovations affecting adoption will be examined through the selection of innovations for study which are characterized by important differences in medical and organizational complexity, number and types of physician users, required referrals, and expense. Following the extensive examination of adoption decisioning in a single HSA, replication is planned in four selected additional HSAs.